This implies that there are two possible routes for psychoanalytic treatment: the transformation of neurotic misery into everyday unhappiness, or politicization. In the former, the unconscious is, to some degree, made conscious. The bizarreness of one’s symptom-language gets partially translated into more socially intelligible speech. Symptoms are lifted, the range of action expanded, and regular unhappiness becomes available as a life-option. Politicization takes the cure in a different direction: it involves the recognition that one’s strange symptoms are not simply a private matter but implicate the wider social environment. Symptoms are in (an oblique) dialogue with society; they are engaged and entangled with its rules, taboos, customs, and ideals, its ideological frameworks and disciplinary practices. Symptom not only impede one’s participation in shared social life; they are mangled and disguised forms of critique. To politicize one’s symptom means to reinsert it into the context that it has fallen out of, so that it can become a lever through which that context might be transformed. This can take many different forms, from relatively minor acts of rebellion and local change to struggles for more systemic solutions, including new ways of creating solidarity with others.

However, this path of politicization is complicated by a few considerations. While symptoms have a social-political dimension—this is what is obscured by a medicalized understanding of mental health—they are never entirely caused by repressive social arrangements and noxious environments, familial, governmental, cultural, economic, or otherwise. It would be wrong to dissolve mental illness into external factors of oppression and abuse. This would be to have a too one-sided view of causality, and to effectively erase psychic causality. Mental illnesses are a distorted mirror of society, and changing symptomatologies reflect the changing times, with its particular conflicts and contradictions, norms and ideals, and collective imaginaries and vocabularies. But psychopathologies cannot be reduced to social pathologies. They bear on universal human problems that societies themselves try to get a grip on and canalize, to repress in the interests of their own reproduction. Politicization can take on a neurotic hue when it turns to culpabilization, and the “Other” made responsible for one’s misery. What makes us is sick is not society per se, but the normative solutions imposed by society for problems that are inherently difficult, if not ultimately impossible, to deal with, problems that have no correct answers but constitute the most vulnerable points in human life and becoming. From a Freudian perspective, freedom consists in the ways we unconsciously respond to such problems, and how we choose which problems will be ours in the first place, that is, the ones that will be the most problematic for us, the so-called “choice of neurosis.” 

The paradox of psychoanalysis is that it asks us to regard symptoms not only as ailments and dysfunctions but, in a positive sense, as warped and furtive forms of freedom. Of course, sufferers wants to be free of their symptoms, to live without excessive fear, anxiety, disgust, and rage, without being plagued by intrusive thoughts, mindless repetitions, and other self-sabotaging behaviors. The symptom appears as an obstacle to living the life one wants to lead. But it can also stand for something else. Instead of seeking to free oneself of the symptom, one might grasp in the symptom an “urge for freedom”—the symptom itself is an expression of freedom in the guise of its opposite, unfreedom.[6] In this case, the symptom is not only an impediment to the flourishing of one’s life, but the signal that there is something wrong with that life (and also, at some level, with life itself: the death drive). The symptom is not merely a problem to be dealt with more or less expediently, but a problem that can force a revaluation of what we think of as problems and solutions, that can put the very framework of how we experience life, pleasure, and desire into question. 

Do all disturbances do this? Not necessarily. Sometimes a cigar is just a cigar, and sometimes a mental disturbance is just a dysfunction. Martin Heidegger had his own version of this: “Concealment can be a refusal or merely a dissembling. We are never fully certain whether it is the one or the other. Concealment conceals and dissembles itself.”[7] In other words: Sometimes a dissembling is just a dissembling, it does not hide a more profound ontological dimension. We can never know for sure whether a particular disruption or distortion is an empirical matter, or whether it concerns the “clearing” itself—and this is part of what concealment is, the obfuscation of the distinction between the ontic and the ontological, dissembling and refusal (Versagung—Lacan will use the same term in another context). Heidegger wouldn’t condone the leap I’m about to make, but the same uncertainty is at stake in the psychoanalytic clinic. It cannot be decided in advance whether a dream or outbreak of anxiety will open onto an unconscious problematic; a distortion in mental life might be only a temporary and accidental glitch or it could point to a wider crisis. A certain wager is involved: entering into psychoanalysis means gambling on the symptom, on the fact that is has something to say that can disrupt and reframe our usual speech about ourselves, the socially consensual vocabularies reproduced in our ego-driven representations. Like Caesar, for the most part we’d rather not be bothered by our “flights” from ourselves and our domesticity, however troubled this domesticity may be. Even further, we’d rather not see these flights as stemming from ourselves at all: “It’s not my fault.” But it is always possible to regard such a desertion as a veritable refusal, and a fugitive opening onto something else, to treat it as the starting point for an “investigation,” to allude to another of Kafka’s dogs, the philosopher hound in the story “Investigations of a Dog."[8] Today, defenders of psychoanalysis point to top quality studies of its long-term effectiveness. This is an interesting development. But this objective validation, according to the most up to date scientific standards, cannot eliminate the uncertainty and subjective risk that lie at the heart of its practice, its Kierkegaardian dimension, if you will. There can be no objective confirmation of the unconscious, and no external authority can vouch for it: it involves an irreducible subjective leap. On the other hand, once one risks the hypothesis of the unconscious, there is nothing that can be definitely excluded from it: the chain of associations spreads in surprising ways, and it can reverberate in the unlikeliest places. The critical point of psychoanalysis might be summarized like this: treating mental disturbance not as a temporary and localized dysfunction but as a structural crisis—a crisis that points to a dense knot (Freud called it the “navel of the dream”) containing accidents of individual history, the conflicts and impasses of social formation, and the singular struggle with universal problems, from the bias of one’s drive-disposition or choice of neurosis.